OB vs. Midwife?

  1. You have chosen to ignore posts from Sally2340. Show Sally2340's posts

    OB vs. Midwife?

    Hi Everyone,

    Ok, so I am a little past 7 weeks and realize I need to choose a doctor!
    I was working with a gyn before but he doesn't do OB anymore so he recommended a hospital midwifery. I guess this is instead of an OB?

    What are the differences? Is everyone else going with an OB instead of a midwife? What are the pros and cons?

    Thanks for your help. I'm new at this and we haven't told anyone we're pregnant yet so I can't start asking people I know... :)

    S
     
  2. You have chosen to ignore posts from sunshinemrs. Show sunshinemrs's posts

    Re: OB vs. Midwife?

    This is a very personal decision.  The basic differences are:

    OBs can perform C-sections should it be necessary.  They tend to be quicker to call for "medical interventions" with birth.

    Midwives can spend more time during each visit with you and tend to have a more holistic approach to birth.

    Neither is good or bad, just generally different in their approach.
     
  3. You have chosen to ignore posts from kargiver. Show kargiver's posts

    Re: OB vs. Midwife?

    I suppose if you're here you can do your own web search, but fwiw, I thought this article was very informative:

    Pregnancy Info Net Article
     
  4. You have chosen to ignore posts from lemonmelon. Show lemonmelon's posts

    Re: OB vs. Midwife?

    If you go with a hospital midwifery practice, you'll still have access to all emergency procedures. I think the big Boston-area hospitals all use midwives as a normal part of their prenatal care and birth -- I know that MGH, the Brigham, and Beth Israel do, anyway. I don't know exactly how it works at those hospitals, but at Mount Auburn in Cambridge, the midwives have their own in-hospital practice. I saw them exclusively throughout the pregnancy and was tended by midwives and nurses through the birth. I saw an OB just once, for the early risk assessment testing. If you are deemed "high risk," the midwives will refer you to an OB anyway. You should call around to various hospitals and ask to take a tour and talk to the midwives. Mount Auburn has a "meet the midwives" thing with snacks and a tour of the birth center.

    I'm not a hippie, but I had a really positive experience at Mount Auburn. They treated pregnancy and birth as the wonderful experience it is, and not as an illness or burden. They were supportive of my decisions and happy to answer all my questions. They were respectful of my choices regarding the birth -- although they encourage natural childbirth, they didn't frown on my decision to get an epidural when the pain became unbearable. They involved my husband in every aspect of the pregnancy and birth (maybe more involved than he wanted to get, in terms of what he witnessed during the birth). And they initiated breastfeeding immediately after delivery and had a lactation consultant visit me repeatedly during my stay. They sent a nurse to my house the day after I left, because I was nervous. And they have free support groups for new moms, with lactation consultants and other experts. And the cafeteria food is incredible. Yum. The rooms are lovely, with blond wood paneling, ipod-compatible sound systems, mood lighting, and views of the Charles.  Although I didn't opt for it, they'll even let you give birth in a big pool of water. It's a wonderful place to have a baby.
     
  5. You have chosen to ignore posts from amy-lynn. Show amy-lynn's posts

    Re: OB vs. Midwife?

    You can also see an OB but still have a midwife assisted delivery. I went to Harvard Vanguard in Quincy for all my appointments. Every third was with the OB, the other two were with an NP (nurse practionioner). I delivered at the Brigham, with the midwives attending the birth. While I was in the hospital, my OB came by on rounds, as well as the midwives, so it is kind of a "best of both worlds" situation. I think it all comes down to who you feel the best connection with. If your doc is recommending the midwives, ask why. Maybe she has had good experiences with them, or has had patients really rave about them. I liked seeing the OB, since this was my first pregnancy, but next time, I wouldn't mind seeing a midwife.
     
  6. You have chosen to ignore posts from Daisy75. Show Daisy75's posts

    Re: OB vs. Midwife?

    "The Business of Being Born" is a documentary about home births (which I know you aren't asking about), but it does have a lot of information about the midwife approach vs. the OB approach.  I know Beth Israel USED TO have midwives but they don't anymore (I looked into it when I got pregnant).  I had been planning to go with a midwife/minimal interventions, but ended up going with an OB because none of the midwife practices that I researched will attend a twin birth--they'll see you for all your visits but when the time comes, an OB will attend your birth.  I did find a fantastic OB who I would recommend to anyone and I did feel that he really understood and supported my desire for a natural, unmedicated birth (I ultimately had an emergency c-section, though).  He also took as much time to answer questions and discuss options as I needed him to, so I never felt rushed.  If you do go with an OB, I recommend going to a smaller, private practice.  You'll get much more individualized attention than if you go with a large practice.  My OB has his own practice and shares call with several other small practices, so I think that made a difference in the amount of time he has for patients.  He's only reporting to himself.  In a large practice, they have to meet quotas and really aren't "allowed" to spend too much time with one patient.

    It is a very personal decision and I think you need to go with what you're most comfortable with.  If you go with a midwife, an OB will ALWAYS be available should you need a c-section or another procedure that the midwife isn't allowed to do, so don't worry too much about the "what-ifs" in that regard.
     
  7. You have chosen to ignore posts from mckate. Show mckate's posts

    Re: OB vs. Midwife?

    The same thing happened to me - my GYN was no longer an OB - she was associated with the Good Sam hospital in Brockton, but recommended the midwives at B&W in Boston. I have been very happy her - she spends time to talk to you, and get to know you as a person.
     
  8. You have chosen to ignore posts from mbg109. Show mbg109's posts

    Re: OB vs. Midwife?

    Sally, good luck making your decision-- obviously a very personal one.  One word of caution (that I have been learning about through my own reading) is that the general thought is that midwives generally allow the labor to progress vs. OBs who are quicker to intervene.  However, that may not be the case for midwives affiliated with hospitals (vs. independent midwifery/birthing centers).  Have you read "Misconceptions" by Naomi Wolf?  I think you have to take her book with a grain of salt-- as anything else you read-- but she addresses this issue directly.  Again, good luck!
     
  9. You have chosen to ignore posts from lemonmelon. Show lemonmelon's posts

    Re: OB vs. Midwife?

    I think that the level of intervention you receive also depends on hospital policy. The Midwives at Mount Auburn (MAMA) list their stats on the website (Births: 691 ::: Primary Cesarean Sections: 107 (15.5%)
    Attempted VBACs: 35 Successful: 26 (74%) ::: Episiotomy Rate: 2.7%

    Epidural: 46.1% ::: Induction Rate: 20.3% ::: Augmentation rate: 34.6%)
    -- I'm not sure if other hospitals do the same, but you could call or email the appropriate department if you are concerned.
     
  10. You have chosen to ignore posts from lemonmelon. Show lemonmelon's posts

    Re: OB vs. Midwife?

    Oh, this makes me want to be pregnant again.
     
  11. You have chosen to ignore posts from SarahInActon. Show SarahInActon's posts

    Re: OB vs. Midwife?

    Hi Sally, the other thing that has to be considered (unfortunately) is your health insurance company.  Sorry to knock the party!  I would have chosen a mid-wife but my heath insurance plan which is BCBS but based out of Utah, didn't cover fully. 

    But Lemonmelon and Daisy have great comments, too.

    The one thing I had with my OB was her wanting me to have an induction when I was 10 days over my due date.  I could have stayed prego longer but she was pretty strong in her view that we induce.  So after stripping the membranes three times in three days and three bouts of cod liver oil, I was only having medium contractions.  A tiny bit of pitocin did the job nicely though a midwife may have let me go longer but who knows.

    Ultimately, my OB told me (a few weeks later after a wonderful birth experience) that she thought DS's head might be getting on the big side.  She didn't want to freak me out by telling me that was why she wanted to induce.  Everything turned out great and we laugh over it now.  She also got to know me really well and knew how obsesive I was so it was good she didn't tell me!
     
  12. You have chosen to ignore posts from Sally2340. Show Sally2340's posts

    Re: OB vs. Midwife?

    Thanks everyone, this is very helpful!

    I actually have BCBS but it may be out of Mass so I'll check. I'll have to do more research into this decision. I have an appt. with my PCP (well, the nurse practitioner there) on Thursday so I'll bring it up there too.

    All this new information to learn! Hopefully I have some time to make it...

    Sally
     
  13. You have chosen to ignore posts from EZola. Show EZola's posts

    Re: OB vs. Midwife?

    Stupid health insurance!

    The midwives at mount auburn aren't a separate thing -- they bill through the hospital. And a doctor is assigned to oversee the whole thing, and his name goes on all the billing or forms in which a doctor's name is involved. So it probably wouldn't matter in terms of insurance coverage. I don't know but would imagine that's probably the case with most hospital midwives.
     
  14. You have chosen to ignore posts from rysmom. Show rysmom's posts

    Re: OB vs. Midwife?

    As for the Insurance thing...EZola is right for some insurances.  Midwives will bill under their supervisory MD the same as an NP would.  BCBS of MA does credential Midwives so Sally you should be all set but it is best to check for your individual plan.  I used to work in Credentialing.
     
  15. You have chosen to ignore posts from luvRIboy. Show luvRIboy's posts

    Re: OB vs. Midwife?

    One thing: there are two kinds of midwives, nurse midwives, who practice in collaboration with docs and deliver in hospitals and birthing centers, and lay midwives, who do not have medical licensure.

    I think we're all talking about nurse midwives here, who are advanced practice nurses, who practice on their own license, but work with an OB in the event that medical intervention is needed. 

    I know that for me (and I almost always see Nurse Practitioners for primary care and OB/GYN stuff), I find that often the doctors are treating my condition, and the nurses are treating me as a person who has a condition.  I feel more comfortable asking questions and having my own opinions with nurses, and for my pregnancy, like that the midwife will be with me throughout the entire labor process, unlike the doctor, who shows up to catch the baby.  

    That said, every practice and every practitioner is different, so you have to find the person you feel most comfortable with!
     
  16. You have chosen to ignore posts from rysmom. Show rysmom's posts

    Re: OB vs. Midwife?

    And to speak a bit to Luv's point...there are generally 2 types or school's of CNM's too.  For lack of better terms, one is more crunchy-granola and the other is more manicured (I've hear CNM's use this language to refer to styles).  Also, I would imagine that insurance would only cover Certified Nurse Midwives services...at least in MA I believe that is the case.  
     

Share